|
SMPL REPAIR S/N/A/G/T 2.6-7.5CM
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
21600103
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$49.69 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$109.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cigna Commercial |
$154.70
|
| Rate for Payer: First Health Commercial |
$163.80
|
| Rate for Payer: First Health Workers Compensation |
$70.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$163.80
|
| Rate for Payer: GEHA Commercial |
$145.60
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$163.80
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$165.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$127.40
|
| Rate for Payer: One Health Plan PPO/POS |
$163.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$172.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$136.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$169.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$72.80
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$49.69
|
|
|
SMPL REPAIR S/N/A/G/T 2.6-7.5CM
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
8823607
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$49.69 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$109.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cigna Commercial |
$154.70
|
| Rate for Payer: First Health Commercial |
$163.80
|
| Rate for Payer: First Health Workers Compensation |
$70.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$163.80
|
| Rate for Payer: GEHA Commercial |
$145.60
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$163.80
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$165.62
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$127.40
|
| Rate for Payer: One Health Plan PPO/POS |
$163.80
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$172.90
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$136.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$169.26
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$72.80
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$49.69
|
|
|
SMPL REPAIR S/N/A/G/T 2.6-7.5CM
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
8823607
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$49.69 |
| Max. Negotiated Rate |
$172.90 |
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cigna Commercial |
$154.70
|
| Rate for Payer: First Health Commercial |
$163.80
|
| Rate for Payer: First Health Workers Compensation |
$70.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$163.80
|
| Rate for Payer: GEHA Commercial |
$127.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$163.80
|
| Rate for Payer: Multiplan All |
$165.62
|
| Rate for Payer: OMNI Networks Commercial |
$127.40
|
| Rate for Payer: One Health Plan PPO/POS |
$163.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$172.90
|
| Rate for Payer: Three Rivers Provider Network All |
$136.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$169.26
|
| Rate for Payer: Zelis Auto |
$72.80
|
| Rate for Payer: Zelis Worker's Compensation |
$49.69
|
|
|
SMPL REPAIR S/N/A/G/T 2.6-7.5CM
|
Facility
|
IP
|
$318.03
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
8512002
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$86.82 |
| Max. Negotiated Rate |
$302.13 |
| Rate for Payer: Cash Price |
$190.82
|
| Rate for Payer: Cigna Commercial |
$270.33
|
| Rate for Payer: First Health Commercial |
$286.23
|
| Rate for Payer: First Health Workers Compensation |
$122.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$286.23
|
| Rate for Payer: GEHA Commercial |
$222.62
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$286.23
|
| Rate for Payer: Multiplan All |
$289.41
|
| Rate for Payer: OMNI Networks Commercial |
$222.62
|
| Rate for Payer: One Health Plan PPO/POS |
$286.23
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$302.13
|
| Rate for Payer: Three Rivers Provider Network All |
$238.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$295.77
|
| Rate for Payer: Zelis Auto |
$127.21
|
| Rate for Payer: Zelis Worker's Compensation |
$86.82
|
|
|
SMPL REPAIR S/N/A/G/T 2.6-7.5CM
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
6112002
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$49.69 |
| Max. Negotiated Rate |
$172.90 |
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cigna Commercial |
$154.70
|
| Rate for Payer: First Health Commercial |
$163.80
|
| Rate for Payer: First Health Workers Compensation |
$70.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$163.80
|
| Rate for Payer: GEHA Commercial |
$127.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$163.80
|
| Rate for Payer: Multiplan All |
$165.62
|
| Rate for Payer: OMNI Networks Commercial |
$127.40
|
| Rate for Payer: One Health Plan PPO/POS |
$163.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$172.90
|
| Rate for Payer: Three Rivers Provider Network All |
$136.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$169.26
|
| Rate for Payer: Zelis Auto |
$72.80
|
| Rate for Payer: Zelis Worker's Compensation |
$49.69
|
|
|
SMPL REPAIR S/N/A/G/T 2.6-7.5CM
|
Facility
|
IP
|
$562.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
8150002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$153.43 |
| Max. Negotiated Rate |
$533.90 |
| Rate for Payer: Cash Price |
$337.20
|
| Rate for Payer: Cigna Commercial |
$477.70
|
| Rate for Payer: First Health Commercial |
$505.80
|
| Rate for Payer: First Health Workers Compensation |
$216.99
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$505.80
|
| Rate for Payer: GEHA Commercial |
$393.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$505.80
|
| Rate for Payer: Multiplan All |
$511.42
|
| Rate for Payer: OMNI Networks Commercial |
$393.40
|
| Rate for Payer: One Health Plan PPO/POS |
$505.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$533.90
|
| Rate for Payer: Three Rivers Provider Network All |
$421.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$522.66
|
| Rate for Payer: Zelis Auto |
$224.80
|
| Rate for Payer: Zelis Worker's Compensation |
$153.43
|
|
|
SMPL REPAIR S/N/A/G/T 2.6-7.5CM
|
Facility
|
OP
|
$318.03
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
7212002
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$86.82 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$190.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$190.82
|
| Rate for Payer: Cash Price |
$190.82
|
| Rate for Payer: Cigna Commercial |
$270.33
|
| Rate for Payer: First Health Commercial |
$286.23
|
| Rate for Payer: First Health Workers Compensation |
$122.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$286.23
|
| Rate for Payer: GEHA Commercial |
$254.42
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$286.23
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$289.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$222.62
|
| Rate for Payer: One Health Plan PPO/POS |
$286.23
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$302.13
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$238.52
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$295.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$127.21
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$86.82
|
|
|
SMPL REPAIR S/N/A/G/T 2.6-7.5CM
|
Facility
|
OP
|
$318.03
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
8512002
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$86.82 |
| Max. Negotiated Rate |
$377.34 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$190.82
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$147.69
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$117.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$188.67
|
| Rate for Payer: Cash Price |
$190.82
|
| Rate for Payer: Cash Price |
$190.82
|
| Rate for Payer: Cigna Commercial |
$270.33
|
| Rate for Payer: First Health Commercial |
$286.23
|
| Rate for Payer: First Health Workers Compensation |
$122.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$286.23
|
| Rate for Payer: GEHA Commercial |
$254.42
|
| Rate for Payer: GEHA Medicare |
$188.67
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$286.23
|
| Rate for Payer: Humana ChoiceCare |
$207.54
|
| Rate for Payer: Humana Medicare Advantage |
$188.67
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$316.97
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$119.38
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$188.67
|
| Rate for Payer: Multiplan All |
$289.41
|
| Rate for Payer: New Mexico Health Connections Medicare |
$320.74
|
| Rate for Payer: OMNI Networks Commercial |
$222.62
|
| Rate for Payer: One Health Plan PPO/POS |
$286.23
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$137.84
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$119.38
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$188.67
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$302.13
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$377.34
|
| Rate for Payer: Three Rivers Provider Network All |
$238.52
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$184.90
|
| Rate for Payer: United Healthcare Managed Medicaid |
$119.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.67
|
| Rate for Payer: United Payors & United Providers UP&UP |
$295.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$188.67
|
| Rate for Payer: Zelis Auto |
$127.21
|
| Rate for Payer: Zelis Medicare |
$160.37
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$226.40
|
| Rate for Payer: Zelis Worker's Compensation |
$86.82
|
|
|
SMPL REPAIR S/N/A/G/T 2.6-7.5CM
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
8223607
|
|
Hospital Revenue Code
|
519
|
| Min. Negotiated Rate |
$49.69 |
| Max. Negotiated Rate |
$172.90 |
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cigna Commercial |
$154.70
|
| Rate for Payer: First Health Commercial |
$163.80
|
| Rate for Payer: First Health Workers Compensation |
$70.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$163.80
|
| Rate for Payer: GEHA Commercial |
$127.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$163.80
|
| Rate for Payer: Multiplan All |
$165.62
|
| Rate for Payer: OMNI Networks Commercial |
$127.40
|
| Rate for Payer: One Health Plan PPO/POS |
$163.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$172.90
|
| Rate for Payer: Three Rivers Provider Network All |
$136.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$169.26
|
| Rate for Payer: Zelis Auto |
$72.80
|
| Rate for Payer: Zelis Worker's Compensation |
$49.69
|
|
|
SMPL REPAIR S/N/A/G/T 2.6-7.5CM
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
21600103
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$49.69 |
| Max. Negotiated Rate |
$172.90 |
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cigna Commercial |
$154.70
|
| Rate for Payer: First Health Commercial |
$163.80
|
| Rate for Payer: First Health Workers Compensation |
$70.27
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$163.80
|
| Rate for Payer: GEHA Commercial |
$127.40
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$163.80
|
| Rate for Payer: Multiplan All |
$165.62
|
| Rate for Payer: OMNI Networks Commercial |
$127.40
|
| Rate for Payer: One Health Plan PPO/POS |
$163.80
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$172.90
|
| Rate for Payer: Three Rivers Provider Network All |
$136.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$169.26
|
| Rate for Payer: Zelis Auto |
$72.80
|
| Rate for Payer: Zelis Worker's Compensation |
$49.69
|
|
|
SMPL REPAIR S/N/A/G/T 2.6-7.5CM
|
Facility
|
IP
|
$318.03
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
7212002
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$86.82 |
| Max. Negotiated Rate |
$302.13 |
| Rate for Payer: Cash Price |
$190.82
|
| Rate for Payer: Cigna Commercial |
$270.33
|
| Rate for Payer: First Health Commercial |
$286.23
|
| Rate for Payer: First Health Workers Compensation |
$122.79
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$286.23
|
| Rate for Payer: GEHA Commercial |
$222.62
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$286.23
|
| Rate for Payer: Multiplan All |
$289.41
|
| Rate for Payer: OMNI Networks Commercial |
$222.62
|
| Rate for Payer: One Health Plan PPO/POS |
$286.23
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$302.13
|
| Rate for Payer: Three Rivers Provider Network All |
$238.52
|
| Rate for Payer: United Payors & United Providers UP&UP |
$295.77
|
| Rate for Payer: Zelis Auto |
$127.21
|
| Rate for Payer: Zelis Worker's Compensation |
$86.82
|
|
|
SMPL RPR SCALP/NECK/AX/GEN/TRNK12.6-20CM
|
Facility
|
IP
|
$297.00
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
6112005
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$81.08 |
| Max. Negotiated Rate |
$282.15 |
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cigna Commercial |
$252.45
|
| Rate for Payer: First Health Commercial |
$267.30
|
| Rate for Payer: First Health Workers Compensation |
$114.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$267.30
|
| Rate for Payer: GEHA Commercial |
$207.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$267.30
|
| Rate for Payer: Multiplan All |
$270.27
|
| Rate for Payer: OMNI Networks Commercial |
$207.90
|
| Rate for Payer: One Health Plan PPO/POS |
$267.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$282.15
|
| Rate for Payer: Three Rivers Provider Network All |
$222.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$276.21
|
| Rate for Payer: Zelis Auto |
$118.80
|
| Rate for Payer: Zelis Worker's Compensation |
$81.08
|
|
|
SMPL RPR SCALP/NECK/AX/GEN/TRNK12.6-20CM
|
Facility
|
IP
|
$297.00
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
21600170
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$81.08 |
| Max. Negotiated Rate |
$282.15 |
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cigna Commercial |
$252.45
|
| Rate for Payer: First Health Commercial |
$267.30
|
| Rate for Payer: First Health Workers Compensation |
$114.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$267.30
|
| Rate for Payer: GEHA Commercial |
$207.90
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$267.30
|
| Rate for Payer: Multiplan All |
$270.27
|
| Rate for Payer: OMNI Networks Commercial |
$207.90
|
| Rate for Payer: One Health Plan PPO/POS |
$267.30
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$282.15
|
| Rate for Payer: Three Rivers Provider Network All |
$222.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$276.21
|
| Rate for Payer: Zelis Auto |
$118.80
|
| Rate for Payer: Zelis Worker's Compensation |
$81.08
|
|
|
SMPL RPR SCALP/NECK/AX/GEN/TRNK12.6-20CM
|
Facility
|
OP
|
$297.00
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
6112005
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$81.08 |
| Max. Negotiated Rate |
$758.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$178.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$108.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cigna Commercial |
$252.45
|
| Rate for Payer: First Health Commercial |
$267.30
|
| Rate for Payer: First Health Workers Compensation |
$114.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$267.30
|
| Rate for Payer: GEHA Commercial |
$237.60
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$267.30
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$110.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$270.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$207.90
|
| Rate for Payer: One Health Plan PPO/POS |
$267.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$127.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$110.68
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$282.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$222.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$110.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$276.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$118.80
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$81.08
|
|
|
SMPL RPR SCALP/NECK/AX/GEN/TRNK12.6-20CM
|
Facility
|
IP
|
$495.45
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
8512005
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$135.26 |
| Max. Negotiated Rate |
$470.68 |
| Rate for Payer: Cash Price |
$297.27
|
| Rate for Payer: Cigna Commercial |
$421.13
|
| Rate for Payer: First Health Commercial |
$445.90
|
| Rate for Payer: First Health Workers Compensation |
$191.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$445.90
|
| Rate for Payer: GEHA Commercial |
$346.81
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$445.90
|
| Rate for Payer: Multiplan All |
$450.86
|
| Rate for Payer: OMNI Networks Commercial |
$346.81
|
| Rate for Payer: One Health Plan PPO/POS |
$445.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$470.68
|
| Rate for Payer: Three Rivers Provider Network All |
$371.59
|
| Rate for Payer: United Payors & United Providers UP&UP |
$460.77
|
| Rate for Payer: Zelis Auto |
$198.18
|
| Rate for Payer: Zelis Worker's Compensation |
$135.26
|
|
|
SMPL RPR SCALP/NECK/AX/GEN/TRNK12.6-20CM
|
Facility
|
IP
|
$495.45
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
7212005
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$135.26 |
| Max. Negotiated Rate |
$470.68 |
| Rate for Payer: Cash Price |
$297.27
|
| Rate for Payer: Cigna Commercial |
$421.13
|
| Rate for Payer: First Health Commercial |
$445.90
|
| Rate for Payer: First Health Workers Compensation |
$191.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$445.90
|
| Rate for Payer: GEHA Commercial |
$346.81
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$445.90
|
| Rate for Payer: Multiplan All |
$450.86
|
| Rate for Payer: OMNI Networks Commercial |
$346.81
|
| Rate for Payer: One Health Plan PPO/POS |
$445.90
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$470.68
|
| Rate for Payer: Three Rivers Provider Network All |
$371.59
|
| Rate for Payer: United Payors & United Providers UP&UP |
$460.77
|
| Rate for Payer: Zelis Auto |
$198.18
|
| Rate for Payer: Zelis Worker's Compensation |
$135.26
|
|
|
SMPL RPR SCALP/NECK/AX/GEN/TRNK12.6-20CM
|
Facility
|
OP
|
$495.45
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
7212005
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$108.47 |
| Max. Negotiated Rate |
$758.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$297.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$108.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$297.27
|
| Rate for Payer: Cash Price |
$297.27
|
| Rate for Payer: Cigna Commercial |
$421.13
|
| Rate for Payer: First Health Commercial |
$445.90
|
| Rate for Payer: First Health Workers Compensation |
$191.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$445.90
|
| Rate for Payer: GEHA Commercial |
$396.36
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$445.90
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$110.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$450.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$346.81
|
| Rate for Payer: One Health Plan PPO/POS |
$445.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$127.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$110.68
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$470.68
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$371.59
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$110.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$460.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$198.18
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$135.26
|
|
|
SMPL RPR SCALP/NECK/AX/GEN/TRNK12.6-20CM
|
Facility
|
OP
|
$678.00
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
8150004
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$108.47 |
| Max. Negotiated Rate |
$758.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$406.80
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$108.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$406.80
|
| Rate for Payer: Cash Price |
$406.80
|
| Rate for Payer: Cigna Commercial |
$576.30
|
| Rate for Payer: First Health Commercial |
$610.20
|
| Rate for Payer: First Health Workers Compensation |
$261.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$610.20
|
| Rate for Payer: GEHA Commercial |
$542.40
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$610.20
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$110.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$616.98
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$474.60
|
| Rate for Payer: One Health Plan PPO/POS |
$610.20
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$127.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$110.68
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$644.10
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$508.50
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$110.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$630.54
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$271.20
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$185.09
|
|
|
SMPL RPR SCALP/NECK/AX/GEN/TRNK12.6-20CM
|
Facility
|
OP
|
$297.00
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
21600170
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$81.08 |
| Max. Negotiated Rate |
$758.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$178.20
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$108.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cigna Commercial |
$252.45
|
| Rate for Payer: First Health Commercial |
$267.30
|
| Rate for Payer: First Health Workers Compensation |
$114.67
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$267.30
|
| Rate for Payer: GEHA Commercial |
$237.60
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$267.30
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$110.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$270.27
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$207.90
|
| Rate for Payer: One Health Plan PPO/POS |
$267.30
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$127.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$110.68
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$282.15
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$222.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$110.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$276.21
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$118.80
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$81.08
|
|
|
SMPL RPR SCALP/NECK/AX/GEN/TRNK12.6-20CM
|
Facility
|
IP
|
$678.00
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
8150004
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$185.09 |
| Max. Negotiated Rate |
$644.10 |
| Rate for Payer: Cash Price |
$406.80
|
| Rate for Payer: Cigna Commercial |
$576.30
|
| Rate for Payer: First Health Commercial |
$610.20
|
| Rate for Payer: First Health Workers Compensation |
$261.78
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$610.20
|
| Rate for Payer: GEHA Commercial |
$474.60
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$610.20
|
| Rate for Payer: Multiplan All |
$616.98
|
| Rate for Payer: OMNI Networks Commercial |
$474.60
|
| Rate for Payer: One Health Plan PPO/POS |
$610.20
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$644.10
|
| Rate for Payer: Three Rivers Provider Network All |
$508.50
|
| Rate for Payer: United Payors & United Providers UP&UP |
$630.54
|
| Rate for Payer: Zelis Auto |
$271.20
|
| Rate for Payer: Zelis Worker's Compensation |
$185.09
|
|
|
SMPL RPR SCALP/NECK/AX/GEN/TRNK12.6-20CM
|
Facility
|
OP
|
$495.45
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
8512005
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$108.47 |
| Max. Negotiated Rate |
$758.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$297.27
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$108.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$297.27
|
| Rate for Payer: Cash Price |
$297.27
|
| Rate for Payer: Cigna Commercial |
$421.13
|
| Rate for Payer: First Health Commercial |
$445.90
|
| Rate for Payer: First Health Workers Compensation |
$191.29
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$445.90
|
| Rate for Payer: GEHA Commercial |
$396.36
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$445.90
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$110.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$450.86
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$346.81
|
| Rate for Payer: One Health Plan PPO/POS |
$445.90
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$127.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$110.68
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$470.68
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$371.59
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$110.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$460.77
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$198.18
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$135.26
|
|
|
SMPL RPR SCALP/NECK/AX/GEN/TRNK20.1-30CM
|
Facility
|
IP
|
$724.00
|
|
| Hospital Charge Code |
8112006
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$197.65 |
| Max. Negotiated Rate |
$687.80 |
| Rate for Payer: Cash Price |
$434.40
|
| Rate for Payer: Cigna Commercial |
$615.40
|
| Rate for Payer: First Health Commercial |
$651.60
|
| Rate for Payer: First Health Workers Compensation |
$279.54
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$651.60
|
| Rate for Payer: GEHA Commercial |
$506.80
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$651.60
|
| Rate for Payer: Multiplan All |
$658.84
|
| Rate for Payer: OMNI Networks Commercial |
$506.80
|
| Rate for Payer: One Health Plan PPO/POS |
$651.60
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$687.80
|
| Rate for Payer: Three Rivers Provider Network All |
$543.00
|
| Rate for Payer: United Payors & United Providers UP&UP |
$673.32
|
| Rate for Payer: Zelis Auto |
$289.60
|
| Rate for Payer: Zelis Worker's Compensation |
$197.65
|
|
|
SMPL RPR SCALP/NECK/AX/GEN/TRNK20.1-30CM
|
Facility
|
OP
|
$365.00
|
|
|
Service Code
|
CPT 12006
|
| Hospital Charge Code |
21600171
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$99.64 |
| Max. Negotiated Rate |
$758.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$219.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$108.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$310.25
|
| Rate for Payer: First Health Commercial |
$328.50
|
| Rate for Payer: First Health Workers Compensation |
$140.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$328.50
|
| Rate for Payer: GEHA Commercial |
$292.00
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$328.50
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$110.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$332.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$255.50
|
| Rate for Payer: One Health Plan PPO/POS |
$328.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$127.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$110.68
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$346.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$273.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$110.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$339.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$146.00
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$99.64
|
|
|
SMPL RPR SCALP/NECK/AX/GEN/TRNK20.1-30CM
|
Facility
|
IP
|
$365.00
|
|
|
Service Code
|
CPT 12006
|
| Hospital Charge Code |
21600171
|
|
Hospital Revenue Code
|
517
|
| Min. Negotiated Rate |
$99.64 |
| Max. Negotiated Rate |
$346.75 |
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$310.25
|
| Rate for Payer: First Health Commercial |
$328.50
|
| Rate for Payer: First Health Workers Compensation |
$140.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$328.50
|
| Rate for Payer: GEHA Commercial |
$255.50
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$328.50
|
| Rate for Payer: Multiplan All |
$332.15
|
| Rate for Payer: OMNI Networks Commercial |
$255.50
|
| Rate for Payer: One Health Plan PPO/POS |
$328.50
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$346.75
|
| Rate for Payer: Three Rivers Provider Network All |
$273.75
|
| Rate for Payer: United Payors & United Providers UP&UP |
$339.45
|
| Rate for Payer: Zelis Auto |
$146.00
|
| Rate for Payer: Zelis Worker's Compensation |
$99.64
|
|
|
SMPL RPR SCALP/NECK/AX/GEN/TRNK20.1-30CM
|
Facility
|
OP
|
$365.00
|
|
|
Service Code
|
CPT 12006
|
| Hospital Charge Code |
6112006
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$99.64 |
| Max. Negotiated Rate |
$758.74 |
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Advantage HMO |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Community HMO |
$219.00
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Blue Preferred |
$136.92
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Managed Medicaid |
$108.47
|
| Rate for Payer: Blue Cross Blue Shield of New Mexico Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$310.25
|
| Rate for Payer: First Health Commercial |
$328.50
|
| Rate for Payer: First Health Workers Compensation |
$140.93
|
| Rate for Payer: Galaxy Health Commercial/Workers Compensation |
$328.50
|
| Rate for Payer: GEHA Commercial |
$292.00
|
| Rate for Payer: GEHA Medicare |
$379.37
|
| Rate for Payer: Great West Healthcare (Cigna) Commercial |
$328.50
|
| Rate for Payer: Humana ChoiceCare |
$417.31
|
| Rate for Payer: Humana Medicare Advantage |
$379.37
|
| Rate for Payer: Molina Healthcare of New Mexico Health Insurance Marketplace |
$637.34
|
| Rate for Payer: Molina Healthcare of New Mexico Medicaid |
$110.68
|
| Rate for Payer: Molina Healthcare of New Mexico Medicare |
$379.37
|
| Rate for Payer: Multiplan All |
$332.15
|
| Rate for Payer: New Mexico Health Connections Medicare |
$644.93
|
| Rate for Payer: OMNI Networks Commercial |
$255.50
|
| Rate for Payer: One Health Plan PPO/POS |
$328.50
|
| Rate for Payer: Presbyterian Health Plan Exchange |
$127.79
|
| Rate for Payer: Presbyterian Health Plan Medicaid |
$110.68
|
| Rate for Payer: Presbyterian Health Plan Medicare HMO/Medicare POS |
$379.37
|
| Rate for Payer: Providence Risk & Insurance Services Commercial |
$346.75
|
| Rate for Payer: Providence Risk & Insurance Services Worker's Compensation |
$758.74
|
| Rate for Payer: Three Rivers Provider Network All |
$273.75
|
| Rate for Payer: TriWest Veterans Administration/VAPC3 |
$371.78
|
| Rate for Payer: United Healthcare Managed Medicaid |
$110.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.37
|
| Rate for Payer: United Payors & United Providers UP&UP |
$339.45
|
| Rate for Payer: VistaCare Hospice Medicaid/Medicare |
$379.37
|
| Rate for Payer: Zelis Auto |
$146.00
|
| Rate for Payer: Zelis Medicare |
$322.46
|
| Rate for Payer: Zelis Primary Direct / Supplemental Network |
$455.24
|
| Rate for Payer: Zelis Worker's Compensation |
$99.64
|
|
